Provider Demographics
NPI:1548487648
Name:J W EMBASSY CORP
Entity type:Organization
Organization Name:J W EMBASSY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-368-8100
Mailing Address - Street 1:200 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4121
Mailing Address - Country:US
Mailing Address - Phone:212-368-8100
Mailing Address - Fax:212-234-1512
Practice Address - Street 1:200 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4121
Practice Address - Country:US
Practice Address - Phone:212-368-8100
Practice Address - Fax:212-234-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 332B00000X, 3336C0004X
NY0169533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3301063OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY01654719Medicaid
3301063OtherNCPDP PROVIDER IDENTIFICATION NUMBER